中枢性性早熟及特发性矮小患儿手腕部不同类型骨骼的成熟特征

［摘要］目的：探讨中枢性性早熟（CPP）和特发性矮小（ISS）患儿手腕部不同类型骨骼的成熟特征，以及不同方法对骨龄（BA）评价的诊断价值。方法：自医院小儿内分泌门诊患儿中选取CPP 25例、ISS 29例和健康对照组21例，同时采用两种方法评价BA： 传统Greulich-Pyle（GP）图谱法； 根据GP图谱对不同骨骼成熟度分别评定法：选取手腕部20块目标骨，分别评定各块骨的BA，取其平均数作为个体BA。各组间进行独立样本t检验，两种评价方法间进行配对t检验。两种方法所得的BA与生活年龄的差值进行ROC曲线分析。结果：与健康对照组相比，传统GP法测定CPP患儿BA超前0.70~2.26(1.48±0.78)岁；不同骨骼成熟度分别评定法测定CPP患儿平均20块骨的BA超前0.28~2.00(1.14±0.86)岁，以掌指骨的骨成熟度超前最为明显：0.34~2.06(1.2±0.86)岁。传统GP法测定ISS患儿BA落后0.47~2.91(-1.69±1.22)岁；不同骨骼成熟度分别评定法测定ISS患儿BA落后0.48~2.50(-1.49±1.01)岁，以腕骨的骨成熟度落后最为明显：0.59~2.73(-1.66±1.07)岁。在健康对照组和ISS组的BA评价中，传统GP法与不同骨骼成熟度分别评定法差异无统计学意义；在CPP组的BA评价中，两种方法间差异有显著意义。两种方法的ROC曲线下面积差异无统计学意义。结论：不同骨骼成熟度分别评定法发现CPP以掌指骨的骨成熟度超前最为显著，ISS以腕骨的骨成熟度落后最为显著。两种方法对CPP、ISS患儿BA评价的诊断价值都较高。

Hand and wrist bone maturation in children with central precocious puberty and idiopathic short stature

［Abstract］Objective： To investigate the maturation of individual bones on the hand and wrist in children with central precocious puberty (CPP) and idiopathic short stature (ISS). Methods： Hand and wrist films of 25 children with CPP，29 children with ISS and 21 normal controls were evaluated by conventional Greulich-Pyle (GP) atlas method and individual bone assessment method，in which all twenty bones of the hand and wrist were evaluated based on GP atlas，including 2 radius and ulna，7 carpal bones，11 metacarpal and phalangeal bones，the average bone age (BA) was calculated.The differences in groups were analyzed by independent samples t test.The differences between the two methods were analyzed by paired sample t test.The differences between BA and chronological age (CA) were analyzed by ROC with SPSS 17.0. Results： Compared with the normal control group，the advance of BA in the CPP group was 0.70-2.26 y(1.48±0.78) by the GP atlas method，while that was 0.28-2.00 y(1.14±0.86) by the individual bone evaluation method.In all twenty bones，the advance of metacarpal and phalangeal BA was the greatest [0.34-2.06 y(1.2±0.86)].In the ISS group，the delay of BA was 0.47-2.91 y(-1.69±1.22) by the GP atlas method，while that was 0.48-2.50 y(-1.49±1.01) by individual bone evaluation method.The delay of carpal BA was the greatest [0.59-2.73 y(-1.66±1.07)] in all twenty bones.In the ISS group and the normal control group，there were no statistic differences between the two methods.In the CPP group，statistic difference was found between two methods.There were no statistic differences for the areas under ROC curves between two methods. Conclusions： The advance of metacarpal and phalangeal BA is the greatest in CPP group and the delay of carpal BA is the greatest in ISS group.Both methods provide diagnostic information for bone age in CPP and ISS children.